In total, 11 trusts had their overall rating reduced as a result of inspection of their self-declared standards.

The original aim was to carry out random spot checks on 10 per cent of trust boards' self declarations of their performance on 24 core standards and to challenge 10 per cent of boards where the commission's external verification identified an anomaly.

If the inspection showed that trusts had falsely claimed to have met a standard they would be penalised. In fact, the commission challenged 15 per cent of trust boards' self declarations - or in the commission's terminology, carried out risk-based inspections.

Ms Walker said: 'I personally became concerned that we could have an arbitrary cut-off point and we asked our regional staff to look at the 10 per cent thrown up as being at risk and to see whether there were any others they would put in. They responded very positively.'

In the end, the commission inspected 648 standards at 128 trusts. It adjusted the declaration in 50 per cent of trusts - 42 per cent in random inspections and 55 per cent in risk-based inspections. The commission gave penalty points for one in four standards after a risk-based assessment and one in eight after a random inspection.

Ms Walker said the commission has already started talks with strategic health authorities about improving the performance of the weakest trusts.

Although the results were not made public until today, all organisations have already been briefed on their individual results and all SHAs are in discussion about how to make improvements, Ms Walker said.

Talks are likely to be more vigorous in SHAs in London and the South East, which have a predominance of poorly performing trusts and high numbers of primary care trusts, which have generally performed worse. The north of England, by contrast, has more high-performing trusts and a concentration of foundation trusts.

One issue is how the newly configured PCTs should make sense of ratings that measured the performance of the old PCTs.

Gary Needle, who headed the commission's work on the health check, said: 'If I was an incoming chief executive I would find these results very useful. It is the most comprehensive assessment of performance and tells me exactly where my organisation is in comparison with others. It gives you a baseline from which to move forwards.'

Mr Needle was chief executive of Brighton and Hove PCT until August last year. This week the PCT was given a weak rating for quality of services, and fair for use of resources.

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